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Waste Tire *Vey & Inspection Re rt <br /> ■ t:.; State of California SURVEY REQUIRED__. ■ <br /> California Cgrated Waste <br /> eManag) Inspection Form Page 2 <br /> Integrated Waste Management Board <br /> Part C Facilit InformationBLUE OR BLACK INK PEN <br /> IS <br /> _ a a <br /> TPID- yy /\ �1 Inspection <br /> Site Suffix: 1 t1 �7 � ) < Report I –��� �� �1"7()]��� I �. <br /> SWIS m Inspection Number on the associated Survey form(Page 1) <br /> Number: I I _ --�_ — Photos Taken Q Yes ® No <br /> Property Owne'Ali f' <br /> Phond Number Marling Addrass <br /> Exempt Business Type Fill if applicablej.. � rw. , ;. �, <br /> Permitted Regulatory Status.(Fill ane) <br /> O PRC §42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exec iption O Permitted 0 Exempt <br /> Excluded Business Types(Fill if applicable) <br /> O PRC §42808-Permitted Solid Waste Facility(Landfill,Transfer Station) O Excluded O Unpermitted <br /> 0 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast Facility Type(Fill rine) <br /> O 14 CCR§18420(a)(4)-Tire retreading facility with no more than 3,000 waste tires on premises O Major WTF (>5,000 Tires) <br /> 0 14 CCR§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> ® 14 CCR§18420(a)(7)&(e)-Tire dealer storing no more than 1,500 waste tires for_90-days ® Minor WTF (500=4,999 Tires) <br /> Part D - Inspection of Waste Tire Facility <br /> V AWASTE TIRE STORAGE STANDARDS �V A <br /> -' , h <br /> 011 i <br /> �11 101.RAW <br /> O 0 PRC§42824-Major Waste Tire Facility Permit 0 (a) Signs 0 (b)Site Attendant O (c)Access <br /> ) J 14 CCR§17353(a)-Vector Control <br /> op 0 PRC§42834-Minor Waste Tire Facility Permit <br /> 0 (1) I npermeable Barrier 0 (2)Approved Vector Plan <br /> PRG§42850(x)-Complies with Terms of Permit <br /> (D14 CC;- ,17354-Storage of Waste Tires,Out doors <br /> Q Q 14 CCR§18420(a)-Applicable for Permit 0 (a)Storage Units <br /> Q Q 14 CCR§18423-Filing Application for Permit (b) Fire Lanes <br /> Q Q 14 CCR§18432-Operations Plan ( (c)Fire District Requirements <br /> 0 (d)Drainage <br /> 0 Q 14 CCR§18433-Emergency Response Plan <br /> 0 (e)Slope/Grade <br /> Recordkeeping Requirement 0 (f)Siting(New Facilities) <br /> O 0 14 CCR§ 18447-Records.Available 0 (g)Rim Removal <br /> 0 0 14 CCR§17351 Fire Prevention Measures 0 (h) Protection from Pyrolytic Oil Runoff <br /> 0 a Communication Equipment <br /> 0 (c)Water Supply 0 (J ', 14 CCR§1735G.-Indoor Storage. <br /> 0 (b)Fire Equipment 0 (d)Other Requirements Facility Compliance with NFPA 231 D-1989 LL <br /> CommentsCA fit ?r(Vl � ec( a "IW°v` ' �o t.-iii( r�J <br /> A YC�c-�(�� c�(a��rlr r�� � , �,r ,y7 h P�. to <br /> A) ►1 c���r� <br /> I i iA " 1/ 1 d- V i�txl old fop- <br /> 11 , 4 <br /> b!A,yw/, lifft foll All vevv i�5 J0 oMil I j ve i <br /> �- '` `� w Gil r t` � 'aC ry` k � t i re <br /> _91Iry*ic h� -iro . lire(, I( 10I ,-0c: ; lekd. Act ulev- on u <br /> UUC -L ko u c It �_ r6I Nil-U lvery 14 G(SOd lit lQ ie <br /> f@ "i ,�' f, V 10��:�1 r r�<, 'vtt" duff P �,o1 oo< 10 I =u ed l -- <br /> 15386 <br /> INSTRUCTIONS ON BACK Correct:0, Incorrect: ( % A P I_.E t 2 <br /> ■ White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />